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View Information Collection (IC)

View Information Collection (IC)

Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only) CM-CPC
 
No Modified
 
Voluntary
 
42 CFR 423.156

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10316 No   Fillable Printable
Form CMS-10316 No   Fillable Printable
Form CMS-10316 No   Fillable Printable
Form CMS-10316 No   Fillable Printable
Form CMS-10316 No   Fillable Printable
Form CMS-10316 No   Fillable Printable
Form CMS-10316 No   Fillable Printable
Form CMS-10316 No   Fillable Printable

Health Health Care Services

 

32,045 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 32,045 0 3,045 0 0 29,000
Annual IC Time Burden (Hours) 6,089 0 -291 0 0 6,380
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Wave 1 cover letter 07/12/2024
Wave 2 cover letter 07/12/2024
Memo on year-to-year variability 07/12/2024
MA_PD Disenrollment Survey crosswalk 07/12/2024
MA-ONLY Disenrollment Survey crosswalk 07/12/2024
Pre-Notification Letter 07/12/2024
Prenote_Vietnamese 07/12/2024
Wave1_Cover_Letter_Vietnamese 07/12/2024
Wave2_Cover_Letter_Vietnamese 07/12/2024
Prenote_Traditional Chinese 07/12/2024
Wave1_Cover_Letter_Traditional Chinese 07/12/2024
Wave2_Cover_Letter_Traditional Chinese 07/12/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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